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Diagnosis of intraductal papillary mucinous neoplasm using endoscopic ultrasound guided microbiopsies: A case report
Charlotte Vestrup Rift1, Bojan Kovacevic2, John Gásdal Karstensen2
1Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.
Abstract:
Pancreatic cysts are increasingly diagnosed due to expanding use of cross-sectional imaging, but current diagnostic modalities have limited diagnostic accuracy. Recently, a novel through-the-needle microbiopsy forceps has become available, offering the possibility of obtaining cyst-wall biopsies. We present a case of 41-year-old male with chronic pancreatitis and a 2-cm pancreatic cyst, initially considered a pseudocyst. Subsequently, endoscopic ultrasound guided microbiopsies were successfully obtained, which surprisingly revealed an intraductal papillary mucinous neoplasm of mixed subtype with low grade dysplasia. In conclusion, obtaining biopsies from the wall of the pancreatic cystic lesions with this novel instrument is feasible and, as demonstrated in this case, can possibly alter the clinical outcome. Microbiopsies offered enough cellular material, allowing supplemental gene mutation analysis, which combined with other modalities could lead to a more individual approach when treating pancreatic cysts. However, prospective studies are warranted before routine clinical implementation.
Insights
Novel microbiopsy forceps enable cyst wall biopsies for pancreatic cysts, revealing an unexpected intraductal papillary mucinous neoplasm. This technique improves diagnostic accuracy and may personalize treatment for pancreatic cystic lesions.
Area of Science:
- Gastroenterology
- Oncology
- Medical Imaging
Background:
- Pancreatic cysts are frequently detected via cross-sectional imaging.
- Current diagnostic methods for pancreatic cysts lack sufficient accuracy.
- A new through-the-needle microbiopsy forceps allows for cyst-wall tissue acquisition.
Observation:
- A 41-year-old male with chronic pancreatitis presented with a 2-cm pancreatic cyst, initially presumed to be a pseudocyst.
- Endoscopic ultrasound-guided microbiopsies were performed on the pancreatic cyst.
- The microbiopsies unexpectedly identified an intraductal papillary mucinous neoplasm (mixed subtype, low-grade dysplasia).
Findings:
- The novel microbiopsy forceps are feasible for obtaining cyst-wall biopsies.
- Microbiopsies provided adequate cellular material for molecular analysis (gene mutation analysis).
- Diagnosis was altered from pseudocyst to intraductal papillary mucinous neoplasm.
Implications:
- This technique can potentially change the clinical management of pancreatic cysts.
- Gene mutation analysis from microbiopsies may enable personalized treatment strategies for pancreatic cysts.
- Further prospective studies are needed before widespread clinical adoption.
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